Objective To analyze the correlation between cumulative fluid balance volume and increasing plasma volume and aggravated clinical congestion symptoms in patients with heart failure on admission for 1～7 d,and to explore the application value of cumulative fluid balance volume in predicting volume overload.Methods Using the convenience sampling method,235 heart failure patients hospitalized from October 2022 to February 2023 in a total of 3 tertiary hospitals in Nanjing,Lianyungang,Jiangsu Province,and Zhumadian,Henan Province,were selected and classified into an increasing/decreasing plasma volume group and an aggravated/alleviated clinical congestion symptoms group.General information,clinical characteristics,and 1～7 d cumulative fluid balance volume of the study subjects were collected to compare the differences in cumulative fluid balance volume between the 2 groups.Logistic regression was used to analyze the effect of cumulative fluid balance volume on plasma volume and clinical congestion symptoms.Receiver operating characteristic curves were used to analyze the optimal cutoff value of cumulative fluid balance volume for predicting increasing plasma volume and aggravated clinical congestion symptoms.Results Excluding 15 pat ients who were discharged early and 3 patients with inaccurate records of fluid intake and excretion,a total of 217 patients were included.The incidence of positive fluid balance was lowest on day 1,at 65.90%,with the smallest cumulative volume of(0.235±0.983)L;the highest incidence of positive balance occurred on day 6,at 75.58%,with the largest cumulative volume of(2.444±5.445)L.The cumulative fluid balance at 4～7 d in the increasing plasma volume group was higher than that in the decreasing plasma volume group,and the difference was statistically significant(P<0.05);the cumulative fluid balance at 4～7 d was an independent risk factor for plasma volume elevation,and a cumulative fluid balance of 2.308,3.361,3.518,and 3.702 L at 4～7 d was predictive of a plasma volume elevation,and areas under receiver operating characteristic curve were 0.686,0.721,0.647,and 0.766,respectively.The cumulative fluid balance for 4～7 d in the aggravated clinical congestion symptoms group was higher than that in the alleviated clinical congestion symptoms group,and the difference was statistically significant(P<0.05);the cumulative fluid balance for 4～7 d was an independent risk factor for the aggravated clinical congestion symptoms,and a cumulative fluid balance for 4～7 d of 2.574,3.383,4.995,and 4.235 L predicted aggravated clinical congestion symptoms,and area under receiver operating characteristic curve was 0.640,0.693,0.654,and 0.720,respectively.Conclusion The incidence of cumulative positive fluid balance in heart failure patients is high,and the amount of cumulative fluid balance can better predict the occurrence of volume overload,and the increase of plasma volume precedes the appearance of clinical congestion symptoms.It is suggested that heart failure patients with more than 3 d of cumulative positive balance should be closely monitored,and when the cumulative positive balance exceeds 2.308 L,measures should be taken in time to drain excessive fluid,so as to avoid the incidence of volume overload.

Objective:To deeply understand the real experience of young and middle-aged lymphoma patients returning to society.Methods:From August to September 2021, 17 young and middle-aged lymphoma patients admitted to the Department of Hematology of the First Affiliated Hospital with Nanjing Medical University were selected as the research object by objective sampling. Phenomenological research method was using to conduct face-to-face in-depth interviews. Colaizzi 7-step analysis method was used to summarize, analyze and refine the theme.Results:A total of 3 first-level themes and 10 second-level themes were extracted. Among them, the willingness to return to society included firm willingness of social return and negative attitude of social return. The scope of social return included returning to work, interpersonal communication, family responsibilities, leisure and entertainment and lifestyle. The influencing mechanism of social return was composed of disease and treatment factors, mental factors, external support and economic capacity.Conclusions:The experience of young and middle-aged lymphoma patients returning to society is a dynamic change process in many aspects. In the future, it is necessary to further explore the status quo of social return of such groups and explore the influencing factors and change tracks of heterogeneity.

Objective:To explore the practice-orientated connotation from the perspective of nursing managers, and provide a reference for the construction of practice-oriented nurse professional title promotion evaluation system.Methods:From January to April 2022, a total of 12 nursing managers from 4 Grade A hospitals in Jiangsu Province were selected by purpose sampling method. The semi-structured interview method was used to interview nursing managers. The data was sorted and analyzed by content analysis method.Results:A total 4 themes were extracted: technical ability (nursing workload, nursing technical difficulty) , quality and safety (patient health outcomes, satisfaction management) , resource utilization (nursing service cost) , contribution.Conclusions:Nursing managers' evaluation of practice-oriented connotation covers several topics, however some indexes are still dominated by subjective evaluation. A scientifically quantifiable practice-oriented nurse professional title promotion evaluation system should be constructed with the help of information technology.

Objective:Based on the real-world clinical data of hospital electronic medical records, to analyze the length of stay and healthcare costs associated with in-hospital falls and fall injuries in hospitals.Methods:Based on the electronic medical record system of the First Affiliated Hospital of Nanjing Medical University, a retrospective cohort study was conducted on patients admitted to these departments reported falls in nursing management information system from January 2017 to December 2019. A total of 38 481 patients from 74 units were enrolled in this study. The patients′ characteristics, falls, falls injury, and explore the length of hospital stay and bottom-up direct cost were analyzed.Results:A total of 243 cases (0.6%) fell and 154 cases (63.4%) were injured by falls from January 2017 to December 2019. Compared with non-fallers, the median length of stay of patients with falls was 19 days, which was significantly increased compared with 7 days of patients without falls ( Z=-15.18, P<0.05). The median hospitalization cost of patients with falls was 39 000 yuan, which was significantly higher than 16 300 yuan of patients without falls ( Z=-11.47, P<0.01). There was no statistical difference between non-injuried fallers and injuried fallers for length of stay and healthcare costs ( Z=-0.92, -0.64, P>0.05). Linear regression model analysis showed that gender, age, comorbidity, inpatient department unit, reason of hospitalization were significantly correlated with inpatient cost and length of stay ( F=280.05, 217.31, all P<0.05). Conclusions:Patients who have an in-hospital fall have significantly longer hospital stays and higher direct costs, mainly can be attributed to the fall itself, not the injury. Our findings have important financial implications for real world in light of optimal intervention strategies, resource allocation and economic evaluation of fall prevention.

Objective:To summarize the best evidence for nutrition management of type 2 diabetes mellitus (T2DM) , so as to provide a reference for formulating nutrition management plans.Methods:According to the "6S" evidence model, evidence-based guidelines, expert consensus, and systematic reviews on nutrition management for T2DM were systematically searched and screened in professional group websites, clinical practice guideline websites and databases. The Appraisal of Guidelines for Research and Evaluation (AGREE) Ⅱwas used to assess the methodological quality of the guideline. Quality evaluation of systematic reviews and expert consensus was conducted according to the appraisal system of the Australian Joanna Briggs Institute (JBI) Evidence-based Health Care Center. The recommended items with the same or similar content were synthesized according to the principle of evidence synthesis, and group discussion was carried out on evidence of conflicting conclusions. The recommendations for nutrition management of T2DM suitable for our national conditions were selected.Results:A total of 5 399 domestic and foreign articles were searched, and 19 articles were finally included, including 8 guidelines, 1 expert consensus, and 10 systematic reviews. The quality evaluation results of 1 guideline were grade A, and 7 guidelines were grade B, and the results of systematic review and expert consensus evaluation were both recommended. According to the principle of evidence synthesis, the recommendations were synthesized, including 5 aspects, namely nutrition management methods, nutrition screening and assessment, energy requirements, macronutrient intake, and micronutrient intake, with a total of 29 pieces of best evidence.Conclusions:Evidence on nutrition management of adults with T2DM is extensive but limited. Macronutrients have similar recommendations. However, there is still a lack of high-quality evidence for micronutrients, especially in terms of whether routine micronutrient supplementation is necessary and the specific intake. Extensive practical exploration and scientific research are needed to enrich the relevant evidence in the field of T2DM.

Objective:To investigate the psychological resilience level of Chinese children and adolescents with type 1 diabetes mellitus (T1DM) and to explore its influence on glucose sugar control.Methods:Using the convenient sampling method, a total of 200 children and adolescents with T1DM in the First Affiliated Hospital of Nanjing Medical University and Nanjing Children's Hospital were selected as research obejcts from January 2019 to January 2021. The general information questionnaire, Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen) and Diabetes Behavior Rating Scale (DBRS) were used to investigate the level of psychological resilience and self-management behavior. And the glycated hemoglobin (HbA1c) value was collected, and analyzed the effect of mental toughness level on it.Results:A total of 200 questionnaires were distributed in this survey, and 196 valid questionnaires were recovered. The total score of DSTAR-Teen for 196 children and adolescents with T1DM was (43.60±8.55) and the total score of DBRS was (0.64±0.16) , the HbA1c value was 7.2% (6.5%, 8.3%) . The results of multiple linear regression analysis showed that the level of mental toughness was an influencing factor of HbA1c level in children and adolescents with T1DM ( P<0.05) . Conclusions:In this study, children and adolescents with T1DM have a higher level of psychological resilience, which may affect their blood glucose control. In the future, interventions that increase the level of mental resilience are suggested to be implemented to promote the improvement of health outcomes of patients.

Objective:To provide reference for the development of a more intelligent and systematic nursing clinical decision support system based on the concept of precision nursing and data sharing, the nursing plan module of clinical decision support system.Methods:An evidence-based knowledge base was constructed based on the nursing process and the standardized nursing terminologies; the nursing plan module was designed according to clinical needs, and the logical reasoning rules were formulated from the generation, sequencing and stopping of nursing problems, objectives, measures and activities, and finally the nursing plan module of clinical decision support system was formed.Results:The nursing plan module of clinical decision support system included the basic information of patients, positive evaluation items and weight values, nursing problems, objectives, measures and activities, etc. the module could automatically deduce the nursing plan according to the patient's individual characteristic index (positive evaluation item), and sort the nursing problems and corresponding measures and activities according to the generation time, weight value and correlation degree. It could automatically distinguish nursing problems, goals, measures and the time of activity stop, and realize intelligent decision-making.Conclusion:The interface of nursing plan module of this system is clear and logical reasoning rules are rigorous. It breaks through the bottleneck of nursing decision-making based on personal professional knowledge and experience in clinical situation for a long time, which can ensure the homogeneity of nursing plan and improve the correctness of decision-making.

Objective:To evaluate and summarize the best evidence of health workers respiratory protection during aerosol-generating procedures in patients with acute respiratory infectious diseases.Methods:We searched EBM Guidelines, Essential Evidence Plus, Dynamed, UpToDate, JBI, BMJ, Clinical Key, Cochrane Library, NICE, AARC, PubMed, EMbase, CKNI, Wanfang to collect related literature including guidelines,evidence summary, recommended practices, standards, consensus and systematic reviews.Results:A total of 20 articles were included, including 10 guidelines, 1 consensus, 2 standards, 2 evidence summaries, and 5 systematic reviews. 24 best evidences including aerosol-generating procedures, training of protective equipment using, principles of protective equipment using, protective equipment using, aerosol operating environment control and medical staff self-monitoring were summarized.Conclusion:The study integrated the best evidence of healthcare workers respiratory protection during aerosol-generating procedures in patients with acute respiratory infectious disease. It is recommended to combine the current status of institutional protection resources and clinical practice experience to promote the conversion of the best evidence to clinical practice.

Objective:To design and develop an unplanned extubation clinical decision support system, aiming to provide a reference for nurses' clinical decision-making.Methods:Through literature review and expert consultation, the knowledge base of the clinical decision support system for unplanned extubation was constructed, and the system function and interface were designed.Results:The authoritative coefficients of the two rounds of expert consultation were 0.853 and 0.867, respectively, and the Kendall ′s W were 0.458 and 0.492, respectively. The final built knowledge base included catheter evaluation module, unplanned extubation evaluation module, and knowledge reasoning rule module. At present, the knowledge base had sorted out 48 first-level items, 9 second-level items, 72 third-level items in the catheter evaluation module, and 5 first-level items, 12 second-level items, and 73 third-level items in the unplanned extubation evaluation module. Entry, 40 knowledge reasoning rules. Conclusions:The clinical decision-making system for unplanned extubation has changed the implementation of unplanned extubation risk early warning, optimized the management process, and realized the interaction of the hospital system. It can conduct dynamic unplanned extubation risk assessment based on individualization and assist nurses Make clinical decisions and promote the safety of nursing management.

Objective:To introduce the construction process and results of the knowledge base in Nursing Decision Support System (NDSS) of the First Affiliated Hospital with Nanjing Medical University, in order to provide references for the development of nursing knowledge base.Methods:From July 2018 to March 2020, based on the "Knowledge Development Process" model, a knowledge base of NDSS covering the entire nursing process was constructed through literature review, expert meetings, and expert consultation methods.Results:The authority coefficients of two rounds of expert consultation were 0.875 and 0.925, and Kendall coordination coefficients were 0.464 and 0.534. The final built knowledge base includes nursing assessment module, nursing problem module, nursing goal module, nursing measure module, nursing activity module and matching rule module. Up to now, the knowledge sorted out 2 213 nursing assessments, 46 nursing questions, 67 nursing goals, 233 nursing goal measurement indexes, 183 nursing measures, 4 783 nursing activities and 3 332 matching rules.Conclusions:The construction process of the NDSS knowledge base has rules to follow and the content can cover the whole process of the nursing procedure. It focuses on the quantitative classification of nursing evaluation and nursing goals, as well as the individualization and pertinence of nursing measures, which can provide references for the development of clinical nursing knowledge base.